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Could someone please explain the difference between the two or are they the same thing? Thanks
Cardioversion Vs. Shock
- Thread starter MD Dreams
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So I was taught to cardiovert a pt. who is having SVT and is hemodynamically unstable. Does that mean we would shock in this case or use meds? Thanks again.
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MD Dreams said:
All unstable patients with signs and symptoms related to the tachycardia (> 150 bpm) should have synchronized (mechanical) cardioversion. If critical, you can go straight to unsynchronized. If you wish to consider antiarrythmic therapy after cardioverting them mechanically, that would be appropriate.
See www.americanheart.org for details on ACLS protocol.
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synchronize for a. fib (svt)
unsynch for v. tach.
If unstable, shock. If stable and a. fib. check with ultrasound to see if there is a clot in the atrium, if not you can cardiovert with meds or shock.
If there is a clot, then, anticoagulate for one month with coumadin. re-check with ultrasound, if clot is gone, then you can shock. in the mean time control the rate with meds. always control the rate. You may not be able to correct the rhythm in older patients, but you can control the rate.
Unstable or stable v. tac gets a shock followed in between with meds.
ACLS. shock , shock , shock.
unsynch for v. tach.
If unstable, shock. If stable and a. fib. check with ultrasound to see if there is a clot in the atrium, if not you can cardiovert with meds or shock.
If there is a clot, then, anticoagulate for one month with coumadin. re-check with ultrasound, if clot is gone, then you can shock. in the mean time control the rate with meds. always control the rate. You may not be able to correct the rhythm in older patients, but you can control the rate.
Unstable or stable v. tac gets a shock followed in between with meds.
ACLS. shock , shock , shock.
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"shock" is probaby a general term but like everyone said there is a different treatment for SVT. Many paramedics I've spoken to prefer to use medication to break an SVT over cardioverson but I've never worked an unstable SVT yet that ACLS calls for cardioverson over drugs, which makes sense.
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one of the smarter people here can answer the questions...
but i think your question is: what is the difference between cardioversion and defibrillation. the short, less detailed answer is....cardioversion is a shock at a particular point in the cycle....whereas the latter is a shock at any point.
but i think your question is: what is the difference between cardioversion and defibrillation. the short, less detailed answer is....cardioversion is a shock at a particular point in the cycle....whereas the latter is a shock at any point.
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cardioversion refers to what you are doing to the heart. Difib. is really the same thing and it refer to a specific thing. Taking someone out of fibrilation.
You can cardiovert someone who is not in fib. they could be in tack.
You can cardiovert someone who is not in fib. they could be in tack.
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Shock can also mean hypotensive secondary to a number of causes.
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MD Dreams, the answer to your question is that a shock (defibrillation) occurs without regard to the electrical cycle. Basically as soon as you hit the button, electricity is delivered across the chest to the heart.
Cardioversion is a defibrillation that occurs at a specific point in the QRS cycle. When you "sync" the defibrillator, it reads the EKG and syncs the defibrillator so the shock occurs on an R wave. The reason for this is that if you shock on a T wave, you will induce ventricular fibrillation because it is during a vulnerable period of repolarization. Some areas are repolarized, some aren't. If the shock occurs there, the areas of repolarization will then depolarize, the non-repolarized area will complete repolarization and then depolarize by stimulation from adjacent tissue. The different areas of repolarization, depolarization, etc. causes ventricular fibrillation.
When you synchronize cardiovert someone, you must hold the "fire" button down for a few seconds until the defibrillator senses an R wave and delivers the shock. Sometimes it takes 3 or 4 QRS complexes to do this. You must re-synchronize the defibrillator by pushing the sync button after each cardioversion. It doesn't automatically re-synchronize.
If the patient has severe hyperkalemia, sometimes the defibrillator can sense tall, peaked T waves as QRS complexes. If you deliver a cardioversion shock that is sync'd on the T wave, you will no doubt induce ventricular fibrillation.
By giving medicines (ibutilide, adenosine, etc.), you are chemically cardioverting the patient. However, for unstable patients, electricity is always the answer and therefore, synchronized electrical cardioversion is the treatment of choice.
Cardioversion is a defibrillation that occurs at a specific point in the QRS cycle. When you "sync" the defibrillator, it reads the EKG and syncs the defibrillator so the shock occurs on an R wave. The reason for this is that if you shock on a T wave, you will induce ventricular fibrillation because it is during a vulnerable period of repolarization. Some areas are repolarized, some aren't. If the shock occurs there, the areas of repolarization will then depolarize, the non-repolarized area will complete repolarization and then depolarize by stimulation from adjacent tissue. The different areas of repolarization, depolarization, etc. causes ventricular fibrillation.
When you synchronize cardiovert someone, you must hold the "fire" button down for a few seconds until the defibrillator senses an R wave and delivers the shock. Sometimes it takes 3 or 4 QRS complexes to do this. You must re-synchronize the defibrillator by pushing the sync button after each cardioversion. It doesn't automatically re-synchronize.
If the patient has severe hyperkalemia, sometimes the defibrillator can sense tall, peaked T waves as QRS complexes. If you deliver a cardioversion shock that is sync'd on the T wave, you will no doubt induce ventricular fibrillation.
By giving medicines (ibutilide, adenosine, etc.), you are chemically cardioverting the patient. However, for unstable patients, electricity is always the answer and therefore, synchronized electrical cardioversion is the treatment of choice.
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emtji said:
I believe this poster gets to the heart of the OPs question. The term "shock" is an imprecise term that can refer both to (1) electrical cardioversion of tachyarrythmias (stable or unstable), which is synchronized to deliver the energy at a particular point during the cardiac cycle and (2) defibrillation of VF/pulseless VT (always unstable), delievered whenever the button is pushed. As others have pointed out, not all "cardioversions" are electric; Stable tachyarrythmias are frequently "cardioverted" with drugs.
